Clinical application of superior lateral genicular artery perforator propeller flap in repair of soft-tissue defects around knee joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Ruomeng ,  LIU Yuanbo , ZHU Shan , ZANG Mengqing , CHEN Bo , LI Shanshan

Scar Comprehensive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P.R.China;

Corresponding author：

LIU Yuanbo, Email: ybpumc@sina.com

Keywords：

Knee joint; soft-tissue defect; superior lateral genicular artery; perforator propeller flap; wound repair

DOI：

10.7507/1002-1892.202106024

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Objective To explore the feasibility and effectiveness of using the superior lateral genicular artery (SLGA) perforator propeller flap to reconstruct soft-tissue defects around the knee joint. Methods Between October 2013 and May 2019, 10 patients underwent repairing of soft-tissue defects around the knee joint using the SLGA perforator propeller flap. There were 6 males and 4 males, with a median age of 34.5 years (range, 6-66 years). Etiologies included radical tumor resection in 4 cases, post-burn scar contracture in 3 cases, post-burn hypertrophic scar in 2 cases, and prothesis exposure after knee arthroplasty in 1 case. Defects located on the lateral knee in 6 cases, proximal lateral leg in 2 cases, popliteal fossa in 1 cases, and infrapatellar region in 1 case. The size of soft-tissue defects was from 6 cm×4 cm to 14 cm×8 cm. The extraction range of the flap was from 10.0 cm×5.5 cm to 23.0 cm×7.0 cm; the length of the perforator pedicle was 2.5-5.0 cm, with an average of 3.65 cm; the flaps were rotated 180°, the large paddle of the propeller flap was used to repair the defect, and the small paddle was used to assist the closure of donor site. Results Blister was observed in the distal 3-cm of one flap and the flap survived after conservative management. All the flaps survived, and the wounds in the donor and recipient areas healed by first intention. There was no vascular crisis, incision dehiscence, infection, or other complications. All 10 patients were followed up 4 to 48 months, with an average of 12.6 months. The color and texture of the flap were similar to those of the recipient area, and there was no need for secondary operation for degreasing and thinning. Scar contracture was corrected; no tumor recurrence was found in tumor patients; the artificial knee joint was preserved, the knee joint flexion and extension activities were good, and all the patient and family members were satisfied with the appearance and function of the lower limbs after operation. Conclusion The SLGA perforator propeller flap surgery is relatively simple without the need of microvascular anastomosis, has the minimal donor-site morbidities, and can provide a compound flap for the repairing of a complex wound. The SLGA perforator propeller flap is one of the optional methods to repair soft-tissue defects around the knee joint.

Citation： YANG Ruomeng, LIU Yuanbo, ZHU Shan, ZANG Mengqing, CHEN Bo, LI Shanshan. Clinical application of superior lateral genicular artery perforator propeller flap in repair of soft-tissue defects around knee joint. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1603-1608. doi: 10.7507/1002-1892.202106024 Copy

1.	Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
2.	Jenwitheesuk K, Sukprasert P, Winaikosol K, et al. Knee reconstruction using a distally based anterolateral thigh flap: an anatomical cadaveric study. J Wound Care, 2018, 27(Sup9a): S28-S31.
3.	Corten K, Struelens B, Evans B, et al. Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement. Bone Joint J, 2013, 95-B(9): 1217-1221.
4.	Kilic A, Denney B, de la Torre J. Reconstruction of knee defects using pedicled gastrocnemius muscle flap with split-thickness skin grafting: A single surgeon’s experience with 21 patients. J Knee Surg, 2019, 32(5): 463-467.
5.	Louer CR, Garcia RM, Earle SA, et al. Free flap reconstruction of the knee: an outcome study of 34 cases. Ann Plast Surg, 2015, 74(1): 57-63.
6.	Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
7.	Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.
8.	Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
9.	Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
10.	Laitung JK. The lower posterolateral thigh flap. Br J Plast Surg, 1989, 42(2): 133-139.
11.	Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
12.	Gstoettner C, Mayer JA, Aman M, et al. Cutaneous angiosome of the chimeric SLGA perforator flap: Anatomical study and clinical considerations. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1142-1149.
13.	Taniguchi Y, Kitano T, Shimoe T, et al. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg, 2009, 25(8): 479-482.
14.	Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
15.	Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
16.	Morsy M, Sur YJ, Akdag O, et al. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg, 2018, 71(1): 33-43.
17.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
18.	Wong VW, Bürger HK, Iorio ML, et al. Lateral femoral condyle flap: An alternative source of vascularized bone from the distal femur. J Hand Surg (Am), 2015, 40(10): 1972-1980.
19.	Han T, Khavanin N, Wu J, et al. Indocyanine green angiography predicts tissue necrosis more accurately than thermal imaging and near-infrared spectroscopy in a rat perforator flap model. Plast Reconstr Surg, 2020, 146(5): 1044-1054.
20.	Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.

1. Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
2. Jenwitheesuk K, Sukprasert P, Winaikosol K, et al. Knee reconstruction using a distally based anterolateral thigh flap: an anatomical cadaveric study. J Wound Care, 2018, 27(Sup9a): S28-S31.
3. Corten K, Struelens B, Evans B, et al. Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement. Bone Joint J, 2013, 95-B(9): 1217-1221.
4. Kilic A, Denney B, de la Torre J. Reconstruction of knee defects using pedicled gastrocnemius muscle flap with split-thickness skin grafting: A single surgeon’s experience with 21 patients. J Knee Surg, 2019, 32(5): 463-467.
5. Louer CR, Garcia RM, Earle SA, et al. Free flap reconstruction of the knee: an outcome study of 34 cases. Ann Plast Surg, 2015, 74(1): 57-63.
6. Fang T, Zhang EW, Lineaweaver WC, et al. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg, 2013, 71(4): 429-433.
7. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.
8. Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
9. Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
10. Laitung JK. The lower posterolateral thigh flap. Br J Plast Surg, 1989, 42(2): 133-139.
11. Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
12. Gstoettner C, Mayer JA, Aman M, et al. Cutaneous angiosome of the chimeric SLGA perforator flap: Anatomical study and clinical considerations. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1142-1149.
13. Taniguchi Y, Kitano T, Shimoe T, et al. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg, 2009, 25(8): 479-482.
14. Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
15. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
16. Morsy M, Sur YJ, Akdag O, et al. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg, 2018, 71(1): 33-43.
17. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.
18. Wong VW, Bürger HK, Iorio ML, et al. Lateral femoral condyle flap: An alternative source of vascularized bone from the distal femur. J Hand Surg (Am), 2015, 40(10): 1972-1980.
19. Han T, Khavanin N, Wu J, et al. Indocyanine green angiography predicts tissue necrosis more accurately than thermal imaging and near-infrared spectroscopy in a rat perforator flap model. Plast Reconstr Surg, 2020, 146(5): 1044-1054.
20. Wong CH, Cui F, Tan BK, et al. Nonlinear finite element simulations to elucidate the determinants of perforator patency in propeller flaps. Ann Plast Surg, 2007, 59(6): 672-678.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of superior lateral genicular artery perforator propeller flap in repair of soft-tissue defects around knee joint

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